AWHONN's clinical issues in perinatal and women's health nursing最新文献

Induced legal abortion remains the leading worldwide fertility regulation method. More than 1.5 million abortions are performed in the United States and Canada annually. Nursing is integral to the care of women who have abortions and their families. The complexity of nursing care is dictated by gestational age, the procedure performed, and patient needs.

A feminist, women's health perspective is described to aid nurses in providing sexual counseling to women having gynecologic surgical procedures. Suggestions are given concerning areas of sexual assessment, resource development, and when and what to teach women about the sexual effects of gynecologic operations.

Nurses and other health care providers are ideal persons to intervene with women who are experiencing violence and abuse in their intimate relationships. All women are not assessed for this health care problem because of lack of education on the part of their health care providers. This article presents principles and methods for the provision of education about women abuse to practicing nurses and students in graduate and undergraduate nursing programs. By redressing this lack of knowledge and skills, nurses will be empowered to provide clinical intervention and leadership in addressing this major health and social problems. Sample outlines and objectives are provided.

Nurses working with pregnant Hispanic women can create barriers in the health care system by not understanding or accepting the variety of ways in which the Hispanic culture perceives and treats pregnancy. This article describes nursing care of low-income, battered Hispanic pregnant women within the context of the Hispanic culture and discusses clinical and nursing implications for interventions. To deliver effective culturally competent care to battered Hispanic pregnant women, nurses need to have a thorough understanding of the variables that influence the health care of Hispanics in the United States, such as the scope of wife abuse in the Hispanic population, sociodemographic characteristics of the Hispanic population in the United States, Hispanic women's access to health care, pregnancy in the Hispanic population, and health care practices of Hispanics in the United States. This will facilitate screening, education, and guidance without upsetting the often precarious security of this period.

Modern medical technology has given us the ability to directly observe the fetus and its state of health. This ability has allowed the fetus to be newly individuated and has supported what often are called conflicts between the fetus and the pregnant woman. This article examines the nature of some of these conflicts and offers support for ethical theories and principles that assume that the pregnant woman is the appropriate decision maker for treatment involving her body and that if she is given support and comprehensible information, her decisions will be in the best interests of her family.

Advances in perinatal technology have led to a preponderance of ethical dilemmas regarding the resuscitation of extremely preterm infants weighing between 500 and 750 grams. Although a review of the literature indicates poor outcomes in many of these infants, an equal number of studies documenting positive outcomes has been reported. A point/counterpoint format is used to discuss the issues related to the borderline viable infant. Strategies for resolution are formulated based on the issues of concern. Prevention of preterm birth, discussion of the resuscitation plan before delivery and initial resuscitation with the option to withdraw treatment are critical solutions to consider. Additional strategies include the establishment of definitive care guidelines and a standardized definition of quality of life. Other options worthy of consideration are discussed.

Standards for decision making in the newborn intensive care unit are discussed, and the implications for increasing involvement of parents in this process is described. Nursing implications are specifically addressed.

Nurses, in their day-to-day practice, are required to combine clinical expertise with skill in moral judgment. Because of the nurse's unique relationship with the patient and a collaborative practice with the physician, the nurse often is at the forefront of identifying ethical dilemmas. In addition to identification of the ethical dilemma, the nurse often actively participates in the decision-making process. Ethical decision-making models bear some resemblance to the nursing process. The nurse plays an active role in each step of assessment, planning, implementation, and evaluation. An increasing number of nurses are formally participating in ethical decision making as a member of hospital ethics committees. The three primary tasks of these committees are: (1) education; (2) policy development; and (3) case consultation. Nursing ethics committees also are being developed to address issues specific to nursing, such as nurse staffing ratios and allocation of nursing resources. Nurses can use ethical rounds or retrospective case studies to perpetuate the study of ethics at the bedside.

The childbearing year is a psychosocial transition that involves changes in roles and status for each member of the family. This change is perhaps most significant in the transition that occurs with the birth of the first child. Thus, childbirth education can be looked upon as an opportunity to strengthen family systems through anticipatory guidance and skill building that family members may use throughout the life cycle.

Sexual violence and older women is a growing problem that is underreported in crime statistics and often not identified by clinicians. Overcoming ageism and acknowledging the sexuality of older women are fundamental to the improved recognition of sexual violence throughout the life span. An epidemiologic analysis of factors associated with sexual violence suggests approaches for prevention, improved recognition, and intervention with older women. The use of geriatric assessment parameters, such as functional assessment, is suggested for older female victims of sexual violence, along with physical examination strategies and follow-up interventions, such as counseling and community referrals. Preventive measures include advocacy for safer environments and counseling about potential vulnerability.